Advances in water intake assessment
Advances in water intake assessment
Jodi Dunmeyer Stookey 0 1
Juergen Koenig 0 1
0 Department of Nutritional Sciences, University of Vienna , Vienna , Austria
1 Children's Hospital Oakland Research Institute , 5700 Martin Luther King Jr. Way, Oakland, CA 94609 , USA
2 Jodi Dunmeyer Stookey
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In the 1990s, water intake was not a priority area for
nutrition research. Water intake data were used by public health
dentists to inform fluoridation initiatives, and by cancer
and infectious-disease epidemiologists to estimate the risk
of water-borne contaminants and carcinogens. Nutrition
researchers, in reaction to the global obesity epidemic,
focused data collection on macronutrient and energy intake,
without tracking water.
Over the past decade, nutritionists’ interest in water
intake has grown along with increasing awareness of the
effects of beverage consumption on obesity and chronic
disease risk. The World Health Organization, European
Food Safety Authority (EFSA), the American Medical
Association, US Centers for Disease Control, and national
Dietary Guidelines in many countries began
recommending drinking water instead of caloric beverages to reduce
obesity and chronic disease risk. Debate over water intake
recommendations drew attention to gaps in the water intake
evidence base.
The articles in this supplement describe recent
methodological and substantive developments in nutrition research
on water intake and outline remaining gaps in knowledge.
Gandy [1] describes inconsistent water intake
assessment between countries, a lack of validated methods, and
the need to standardize international efforts to estimate
water intake. Water intake assessment methods have yet
to be validated against objective biomarkers, such as water
turnover. Unknown potential for measurement error limits
interpretation of existing water intake data.
Bardosono et al. [2] explore the potential for error in
water intake estimates derived by 24-h recall. Although
one 24-h diet recall is generally understood to adequately
estimate the energy and macronutrient intake of a group,
these authors report significant underestimation of
absolute beverage intake for groups of adolescents and adults,
relative to a 7-day diet record. One 24-h recall appears
to only yield valid estimates of relative fluid intake for
groups, i.e. drinking water expressed as a percentage of
total fluid intake. Although the data support use of one
24-h recall to evaluate interventions promoting relative
beverage change, i.e. drinking water instead of caloric
beverages, at the community- or group-level, it remains to
be determined if and how sources of error in water intake
estimation can be reduced.
While a 7-day record appears to be a more reliable
method to capture fluid intake, the burden associated with
this instrument may impact its usability and acceptance in
the general population. Monnerie et al. [3] provide data
of a study comparing an online version of a 7-day record
with a paper version of this instrument. They report that
the online version resulted in higher water intake from
fluids and a higher acceptance of the online version by the
respondents.
Lack of standardization and potential for measurement
error, notwithstanding, water intake datasets are
emerging from various countries worldwide. Iglesia et al. [4],
Guelinckx et al. [5], and Ferreira-Pêgo et al. [6] describe
absolute and relative water intake in children, adolescents,
and adults from surveys with similar 7-day water intake
assessment methodologies in 13 countries.
The emerging data signal that low water intake may be
an issue of global concern, warranting continued effort to
improve assessment techniques, inform, and implement
international water intake recommendations. In 12 out of
13 datasets analyzed by Iglesia et al. [4], estimated water
intakes are below the EFSA standards for over 20 % of
children and adolescents. In many countries, drinking water
accounts for less than half of reported fluid intake for
children [5]. Overall, only 40 % of men and 60 % of women
surveyed appear to meet the acceptable intakes for water
intake from fluids as set by EFSA [6].
Guelinckx et al. [7] report that intake volumes of
different beverage types differ considerably between
countries for adults, but the differences are only modest between
countries from the same geographical area. They also
observe that intake of free sugar resulting from sweetened
beverages exceeds the WHO recommendations on free
sugar intake to a different extent between countries. While
11–49 % of adults exceeded this recommendation in Spain,
France, Turkey, Iran, Indonesia, and China, 48–62 % of
adults were found to exceed the recommendations in
Germany, UK, Poland, and Japan, and 60–66 % of adults in
Mexico, Brazil, and Argentina.
Accumulating data indicate sub-optimal water intake in
multiple countries, and variability in water intake by age,
sex, socio-economic status, country, and world region.
These findings have pot (...truncated)